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Early management of trauma
patient in the hospital
Logeshini Palaniappan
Group D1Guided by Professor Dinker Pai
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Phases of initial assessment
Primary survey
Secondary survey
Definitive care
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Triage categories
Red( critical)
Yellow(semi critical)
Green(non critical) Black
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Red
Major trauma
Life threatening conditions
Shock states Airway compromise
Severe respiratory distress
Seizuring patient
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Coma
Head injury
Severe crush injuries to limbs Burn to more than 25% BSA
Gun-shot wound
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Yellow
Altered conscious level
Head injury
Fractures Dislocation of major joints
Spine injuries
Eye injuries
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Limb amputation
Burn 15% - 25% of BSA
Vascular injuries Uncontrollable major bleeding
Severe pain
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Green
Close fracture of upper limbs or ankle
Dislocations of small joints
Burns
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Trauma team
Trauma team leader
Primary resuscitator
Airway manager Respiratory technician
Assistant
Trauma nurse Recorder
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Radiology technologist
Laboratory technician
Case manager
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Cervical spine stabilization first!
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Airway
Suctioning/Mechanical removal
Chin lift/jaw thrust maneuver
Oropharyngeal/Nasopharyngeal airway Endotracheal intubation
Surgical airway
Tracheostomy
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Breathing
Inspection
Palpation
Percussion Auscultation
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Circulation
External haemorrhage-direct pressure
Internal haemorrhage-skin colour, pulse,
blood pressure
2 large bore IV lines
Fluid resuscitation
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Disability
Level of consciousness-GCS
-Eye opening(4)
-Best verbal respone(5)-Best motor response(6)
Pupillary response
Movement
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Exposure
Head to toe examination
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Adjuncts to the primary survey
Blood samples- FBC, urea and electrolytes,
clotting screen, glucose, blood grouping and
cross matching
ECG monitoring
Pulse oximetry
Urinary and gastric catheters
Imaging
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Radiographs
Lateral cervical spine x-ray
Anteroposterior chest x-ray
Anteroposterior pelvic x-ray Extremity x-ray
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Imaging
FAST
CT angiogram
CT scan of head CT scan of abdomen
CT chest
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Secondary Survey
History-A
M
PL
E
Head to toe examination
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References
The trauma manual-trauma and acute care
surgery, Lippincott Williams and Wilkins
3rdedition
Bailey and Loves Short Practice of Surgery 25th
edition
Sabiston 18thedition, volume 1
Emergency Medicine News September 2010
www.medscape.com/emedicine
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